top student at medical school

Chapter 296 A Truly Honest Man (Please Subscribe)
"Director Qiu, what's the situation with this patient?"

Associate Professor Qiu from the Department of Anesthesiology is also the deputy chief physician in the department, but the director of the Department of Anesthesiology still respectfully calls him Director Qiu.

"Director Zeng, when he was brought in from the emergency room, we considered it to be traumatic hypotension due to blood loss, but at that time there were no signs of shock."

"After the procedure was officially started, although there was still bleeding, the blood pressure was managed to remain stable thanks to blood transfusions."

“But now, the trauma surgeons have completed the debridement and exploration procedures, and no active bleeding has been found. The patient’s blood pressure has not risen either…” Associate Professor Qiu quickly reported the situation to the head of the anesthesiology department.

Associate Professor Qiu's physique is difficult to describe in terms of absolute fatness or thinness. If you only look at his belly, he should be a very fat man, but if you look at the rest of his body, he should be a strong and healthy man.

As Associate Professor Qiu explained, the head of the anesthesiology department, a tall, strong, and muscular middle-aged man whose physique was clearly superior to Associate Professor Qiu's, immediately frowned.

Looking at the two little ones on the operating table, he asked, "Since shock isn't under the jurisdiction of orthopedics, what are those two doing?"

Zeng Quanming had a square face, a serious expression and eyes, as if he had experienced many life-and-death trials.

His tone was calm but tinged with sarcasm.

Associate Professor Qiu's eyes darkened slightly beneath her floral hat: "Director Zeng, the other surgeons have already consulted, and they all say that the shock is unrelated to the diseases in their respective departments."

"All that's left are open injuries in orthopedics."

"Now that the orthopedic surgery is complete, wouldn't he have become a shock patient?"

"The patient's current blood pressure? It's relatively good." Qiu Yuxuan glanced at the monitor. Although he had great confidence in his skills, Qiu Yuxuan was also feeling quite anxious.

He was fully aware of how troublesome it would be if a patient on the operating table had an unclear diagnosis and was still in shock.

As Director Zeng and Associate Professor Qiu of the Anesthesiology Department stared at each other, the head nurse of the Operating Room finally walked in. However, she didn't dare to ask about the trouble in the Anesthesiology Department, but instead shouted.

"You surgeons didn't even figure out the cause of the illness, so why did you send her for surgery? Look at how you're going to clean this up now!" The complaining voice that came in betrayed her age of over forty and her fierce, motherly nature.

Upon hearing this, Fang Ziye looked up but didn't speak. Instead, he gestured to his junior apprentice, Jie Han, to continue stitching.

Perhaps seeing that Fang Ziye was relatively honest, the head nurse came again: "Why don't you call your superiors right away?"

"So what's the next step here?"

Upon hearing this, Fang Ziye finally said, "Teacher, could you please give us some guidance on how to proceed?"

"I'm not a doctor, why are you asking me? If asking me is of any use, then what's the point of having doctors?" The woman said very frankly, without a trace of guilt, but rather with sarcasm.

Fang Ziye lowered his head and said in a low voice, "I thought you came here for a consultation and to guide the surgical indications."

"What?" The middle-aged woman, who was always outspoken and rarely respected even by professors of surgery, spoke with disbelief.

"It's nothing!" Fang Ziye lowered his head and continued to close the wound with Jie Han.

Upon hearing this, the head of the anesthesiology department finally spoke up: "Head nurse, open wounds are a surgical indication. Surgery is a large department, and surgical indications for orthopedics are specific to orthopedics. It's not fair to generalize."

The woman started grumbling, "Director Zeng, you're still too lenient with these people in surgery. We're all in the same department, why do they get to..."

As the woman was showing off her voice, the operating room door opened, and a young man entered. He was wearing black-rimmed glasses and, as soon as he stepped inside, wanted to rush to the anesthesiology department's computer to review the images again.

Upon seeing this, Zeng Quanming looked the other person up and down and asked, "Which subject are you a teacher in?"

The young man trembled slightly upon hearing this before saying, "Director Zeng, it's me, from the vascular surgery department."

Zeng Quanming seemed to have recognized the other person immediately: "You're the one from the vascular surgery department, right?"

"Director Zeng, when you called just now, our department head, Director Wu, really couldn't get away. It's an abdominal aorta to femoral artery replacement surgery! Besides Director Wu, no one in our team can fill in," the young man quickly explained.

Knowing he had been caught red-handed for sneaking in, he realized that he was only an attending physician and not really qualified to answer a consultation call from Zeng Quanming, a senior department head.

"Shock Chain, your vascular surgery department has the heaviest workload. You need to think this through carefully!"

"I just looked at the medical records. When the patient was in the emergency department, he was already being consulted by attending physicians from neurosurgery, gastrointestinal surgery, thoracic surgery, hepatobiliary surgery, and thoracic surgery." Zeng Quanming reminded the young man to recognize reality.

"Hey, thank you, Teacher Zeng. I will be very careful." The young man wasn't particularly flustered.

The Department of Thoracic Surgery and Department of Cardiac Surgery at Zhongnan Hospital are combined. The Department of Vascular Surgery mainly deals with injuries to other major arteries besides the thoracic aorta.

Other small artery injuries are actually attributed to various subspecialties.

In addition, there are treatments for thrombosis, which fall under the jurisdiction of vascular surgery.

If the bleeding is to an organ, local hemostasis is not within the scope of vascular surgery, at least not at Zhongnan Hospital.

Specialized treatment does not mean that vascular surgeons need to perform hemostasis on your hemorrhoidal blood vessels.

What the young man could think of, Zeng Quanming could also think of, so he muttered a curse under his breath.

"Wu Yong, that bastard."

Upon hearing this, the young man raised his eyelids slightly. Although he clearly heard Zeng Quanming cursing his own department head and the professor in charge of his research group, he still dared not retort.

The young man obediently began reviewing the X-rays, making a second diagnosis, and then reading through the previous medical records, trying to deduce the true diagnosis by looking at the physical examination notes written by others...

The patient is already on the operating table; it's impossible to take him off for another examination. The current trauma surgery is not yet nearing completion.

No one can violate the principle of aseptic technique.

The real task of the emergency consultation is to find other hidden bleeding points besides open limb injuries.

……

Consultants from other departments also arrived one after another.

Although some of the people who came from other departments were professors and others were associate professors, Zeng Quanming didn't have any temper.

Different departments also have subspecialties.

Being a professor doesn't necessarily mean being the best at something.

The attendance requirement for a hospital-wide consultation is only associate professor or above, so what else can he say?

Of course, while everyone else was arguing heatedly, Fang Ziye and Jie Han were sewing with great calm and composure.

It wasn't that the two of them were deliberately stalling for time; they simply didn't dare to be careless. So, in the suturing procedure, they went all out, maximizing both speed and quality.

The neurosurgical consultation hasn't even arrived yet, and it might not even happen.

Fang Ziye had already finished the surgery. After covering the patient with a sterile dressing, he said to the anesthesiologist, "Professor Qiu, our emergency orthopedic surgery is complete. If the patient's vital signs are stable, he can be transferred directly to the ward."

"But if the blood pressure is unstable, it is still recommended to transfer to the ICU."

"Regarding communication with the patient's family, I just heard how much effort you all put into it, so I..." Fang Ziye gave these instructions and then dismissed Jie Han.

Having just been reprimanded by his master Yuan Weihong that morning, Fang Ziye naturally wouldn't want to go yo-yoing again during a non-emergency situation.

This patient could very well cause a medical dispute and even lead to death.

Fang Ziye would definitely not leave halfway through; he would be present the entire time. Even when people from other departments were performing surgery, or even when Fang Ziye had finished dealing with all the orthopedic matters, he would still insist on being present.

Fang Ziye stood to the side, calm and cautious like a turtle.

Many people were furious.

This anger wasn't just about Fang Ziye's current caution, but also about his not ruling out using a cautious approach to achieve his goal of simply observing the situation.

What's even more infuriating is that the emergency surgery team insisted on putting the orthopedics team first, making them the last to request an emergency consultation.

That's good, Fang Ziye is just a completely honest person.

Surprisingly, he didn't object immediately. He's not a seasoned veteran; he doesn't shy away from his department's tasks and scope of work. He only told others that the shock was unrelated to orthopedics after pulling the patient into the operating room.

The hospital operates on a first-visit responsibility system. The emergency department is the first-visit department.

Therefore, during emergency room visits, it is the emergency department's prerogative to decide which departments to invite for consultation and which not to invite.

The emergency department has the right to decide which departments to consult with in which order.

After Fang Ziye had consulted with other departments besides the emergency department, he would come for another consultation, and naturally he would be responsible for exploring and stopping the bleeding of the traumatic injury.

Unlike Fang Ziye's composure, Deng Zhi was now somewhat panicked.

Although he had fulfilled his duties as the chief resident of the emergency department by transferring the patient to a specialist ward.

However, Fang Ziye has now transferred the patient from the specialist department to the anesthesiology department, and the anesthesiology department will naturally send the patient back to the emergency department.

How could requesting consultations and investigating specialist diagnoses possibly be the responsibility of the anesthesiology department?
Therefore, Deng Zhi's hair is no longer flowing.

His brows were furrowed as he made a wider-ranging phone call, and even the head of the emergency department's administration rushed over to help clean up the mess.

This is the current situation.

All the consultations requested by the emergency department have been completed, but the true cause of the shock has still not been found.

In other words, the emergency department did not find the right department to consult.

The patient has not yet arrived at the orthopedic ward.

Therefore, patients are either under the jurisdiction of the anesthesiology department or the emergency surgery department that sends them for emergency surgery.

Trauma surgery and orthopedics departments certainly don't handle consultations or similar matters.

Fang Ziye's consultation opinion stated that the diagnosis of open injury to the lower extremities was clear, and there was an indication for emergency surgical exploration and treatment. If there was vascular injury, hemostasis should be performed.

The current open wound has not resulted in significant blood loss, suggesting a non-hemorrhagic shock as the primary cause. Consultation with other specialists is recommended for further diagnosis and treatment.

Fang Ziye only mentioned stopping the bleeding and exploring, but did not mention correcting the shock.

It was as if Fang Ziye had foreseen something in advance, but he didn't want to give any advice or suggestions on which specialist to consult in the emergency surgery department.

Moreover, although Fang Ziye arrived last and these opinions needed to be written, the emergency department had already done it in advance, so they didn't take it seriously.

Whether you take it seriously or not, the program is correct.

……

Jie Han left, going to the actual operating room of the trauma surgery department.

After completing his own surgery, Fang Ziye remained in the operating room, listening and observing.

Of course, what I heard was mostly the head-shaking and voices of a group of associate professors and attending physicians.

"This is strange, there's nothing wrong with it, is there?"

"Based on the current CT scan, there are no bleeding lesions in the chest or abdomen."

"Isn't this hemorrhagic shock?"

"How could it not be hemorrhagic shock? All shocks are essentially hemorrhagic..." someone started lecturing.

But no one refuted it. Those who have reached this level in their professional titles cannot possibly have any problems. They have been immersed in some basic theories for one or two decades. How could they possibly make mistakes?

Shock is defined as an absolute or relative deficiency of blood volume.

The CT scan did not show any bleeding points, but...?
Shock still exists.

Five minutes had passed since their surgery ended, and no one had reached a conclusion.

Fang Ziye was also helpless; in the end, he didn't want to cause trouble for the sake of this matter.

The value of knowledge lies in its application.

It doesn't matter which patient you use it on, because the ultimate result is to improve your skill level and proficiency.

Therefore, Fang Ziye could only upgrade his CT scan interpretation skills by one level.

Soon, my CT scan reading skills will reach level 5 proficiency.

Then, Fang Ziye was once again at the computer, watching an unknown associate professor repeatedly reviewing the patient's CT scan results.

At first glance, there is no bleeding foci.

Upon closer inspection, there were still no bleeding foci.

Upon closer inspection, the blood vessels between the various organs are actually in good condition, without any signs of rupture or other symptoms.

so?

So it really wasn't hemorrhagic shock?

But if it's not hemorrhagic shock, why is the patient's blood pressure so low?
The blood oxygen level was also not high.

The heart's pumping volume is fine, right? The patient had cardiac ultrasound monitoring during the surgery.

In that case, there must be other problems.

What kind of problem is that?
After a while, when Fang Ziye examined his abdomen again, he finally realized what was going on.

Well, that’s it.

Everything's completely dark right under our noses.

Everyone only noticed the bleeding and didn't really consider the relatively insufficient blood volume.

Furthermore, it did not take into account an extremely low probability.

The possibility of recurrent arterial dissection after CT scan.

Fang Ziye then suggested, "Brother Deng Zhi, why don't you have that vascular surgeon examine your abdomen again more carefully?"

"What?" Deng Zhi was in a state of great turmoil and didn't hear what Fang Ziye was saying at all.

"I suggested, 'How about we do another bedside CT scan or an abdominal vascular ultrasound?'" Fang Ziye offered a more direct and simple suggestion.

“Bedside CT scans in the operating room are very difficult to perform, but color Doppler ultrasound is not difficult at all. What do you guess the diagnosis is?”

"The patient was in a coma when the aortic dissection was discovered."

"Or it could be described as traumatic, delayed arterial dissection," Fang Ziye suggested.

"That's impossible!"

"How could aortic dissection not be diagnosed? Vascular surgeons have seen it countless times."

“We often see imaging findings of aortic dissections, let alone when the patient has had a CTA,” Deng Zhi immediately refuted Fang Ziye’s suggestion.

"Then let's get an ultrasound done. There's nothing else we can do right now anyway," Fang Ziye said, backing down.

The surgery is over, and aseptic technique is no longer required.

So, Associate Professor Qiu Yuxuan from the Department of Anesthesiology did indeed examine the patient's abdomen, and when the ultrasound probe was inserted, it was discovered that the diameter of the blood vessels was not quite right...

Almost everyone present was stunned.

Then, when we looked at Fang Ziye, who had made the suggestion, he had already stepped through the sensor door and left the operating room, leaving only a quiet, unassuming figure behind.

(End of this chapter)